Contemporary strategy for aortic valve stenosis in octogenarians

The number of patients with aortic stenosis (AS) has been increasing over recent decades with the longer life expectancy of the general population. AS is life-threatening without surgery and since many elderly patients have a variety of comorbid conditions, 30–40 % of those with severe AS have been denied surgery. However, recent data on standard aortic valve replacement (AVR) for octogenarians have revealed excellent outcomes, with 2.4–6.8 % early mortality and similar survival rates of octogenarians who undergo AVR vs. the general population. The reported incidences of postoperative stroke, dialysis, and pacemaker implantation were 2.4, 2.6, and 4.6 %, respectively. Transcatheter aortic valve replacement (TAVR) is the alternative therapy for patients who are not able to undergo standard AVR and it is developing rapidly. The placement of aortic transcatheter valves (PARTNER) trial showed acceptable early outcomes. The mortality rates from any cause were 3.4 % in the TAVR group and 6.5 % in the AVR group at 30 days, 24.2 and 26.8 % at 1 year, and 33.9 and 35.0 % at 2 years, respectively. Stroke rate was higher in the TAVR group than in the AVR group (3.4 vs. 1.9 %). Vascular complications and paravalvular leakage are frequent procedure-related complications, which must be addressed because they are associated with increased mortality.